Sick on Saturday

A few weeks ago, after having my hair colored at a salon (see previous blog entitled ’45’ for subconscious backstory) I most likely had an allergic reaction to PPD or para-phenylenediamine a chemical found in hair dyes and temporary tattoos. My scalp became raw, my eyes swelled and the right side of my face was puffed out a few inches.

Please, reader note the fact that my husband’s primary response to my initial hysteria was, “Hm, your face doesn’t look THAT bad.” But by the next morning, he stared hard at my face, pulled out his iPhone and called my doctor.

As a health care reform advocate sitting here now fully recovered, I have to note the implications of my experience for what it says about our health care system. First of all, the chemical that caused the allergic reaction is a known alergen banned in quite a few European countries. When I suggested to my emergency room doc that this was an oh so rare reaction, he said, “Uh not really. We had another woman in here last week.”

Second, I ended up in the hospital emergency room. Not because I required critical, highly technical care, but for one simple reason: I got sick on a Saturday. If my allergic reaction had occurred during a workday, I would have called my doctor and hopefully he’d have managed to fit me in on the same day.

Now some of you will say, who cares? You have insurance. You got excellent care. What are you complaining about? But I know that the cost of the care I received is my contribution to the 30% waste in the system. Quite simply it means the system spent more on me and will necessarily spend less on someone else. Fixing this isn’t rationing, it’s just erasing stupidity.

When we called my physician’s on-call line at 8:30am on Saturday and talked to the perfectly nice doctor who happened to be on pager duty that morning, he told me to go to the emergency room. “Really?” I asked.

“Really,” he said.

“Is it an emergency?” I asked.

“Well, today it is.”

Now if I walk into Whole Foods for a loaf of bread on Sunday morning, it doesn’t cost me 5 times more than it would Monday afternoon. But a doctor’s visit does. If you want to fill up your gas tank on your way home from your kid’s soccer game at dinnertime on Saturday, it doesn’t come with an automatic 300% surcharge. But in health care it would. If we are going to get serious about health reform we have to figure out how to fix this.

Sickness on Saturday should not an emergency make. Just as whether I have a job shouldn’t determine whether I have health insurance, when I get sick shouldn’t automatically mean a 2, 4 or 600% difference in the cost of care.

We have got to make this system more affordable by making expensive things — like ER visits for non-emergency issues, preventable hospitalizations or duplicative testing, rare and dear. And reasonably priced things — like prevention, primary care, and sensible triage — readily available and inexpensive. Guaranteed we will have more of the latter and need less of the former. That’s real reform.

One step is to start by listening to the people who know how to do this.